News & Updates

In cooperation with the American Ambulance Associationwe and others have created a running compilation of local and national news stories relating to EMS delivery, powered by EMSIntel.org. Since January 2021, 2,678 news reports have been chronicled, with 42% highlighting the EMS staffing crisis, and 38% highlighting the funding crisis. Combined reports of staffing and/or funding account for 79.5% of the media reports! 201 reports cite EMS system closures/takeovers, or agencies departing communities, and 94% of the news articles reference staffing challenges, funding issues and response times.


Click below for an up to date list of these news stories, with links to the source documents.

Media Log Rolling Totals Protected.xlsx

  • 19 Aug 2024 6:46 AM | Matt Zavadsky (Administrator)

    Kudos to the San Antonio City Manager for proposing increases to the ambulance fees charged by the fire department.
     
    It’s generally good public policy to reduce tax burden for ambulance service by charging a market rate for those services. Under-billing (referred to recently by a Texas Medicaid official as a ‘nominal fee’) essentially uses tax dollars to subsidize commercial insurers.
     
    Medicare and Medicaid reimburse ambulance agencies at a fixed fee schedule, and patients are not balance billed. Self-pay patients generally don’t pay. Commercial insurers typically reimburse 80% of what they determine to be the usual and customary rate, or 80% of billed charges.
     
    Charging an appropriate market rate helps assure the commercial insurers are reimbursing at a reasonable rate.
     
    Also, many states are proposing GEMT programs that are not cost-based, but instead based on the difference between what Medicaid reimburses and the average commercial reimbursement.
     
    Departments that do ‘nominal’ billing (billing far below the market rate) are penalizing taxpayers (by not maximizing insurance reimbursement), and each other (by lowering the average commercial reimbursement calculation).
     
    It’s reasonable public policy to charge fees that maximize commercial reimbursement and implement charity care policies for patients without health insurance.


    San Antonians could soon pay more for ambulance transport. Here's why.
    The proposed rate increase for ambulance rides in San Antonio would go from $1,000 to $1,500 in two years.
    Author: Meredith Haas
    August 16, 2024
     
    https://www.kens5.com/article/news/politics/san-antonio-proposes-rate-increase-ems-transports-kens5/273-27125857-608f-402d-b620-6ee28cc123cd
     
    SAN ANTONIO — The City of San Antonio is considering upping the price of ambulance rides by hundreds of dollars.
     
    There hasn’t been an increase in this medical cost since 2019, but one City Council member is speaking out against the proposal. In a Thursday meeting, City Manager Erik Walsh recommended raising the current EMS transport fee from $1,000 to $1,500 in the next two years, as part of a budget proposal presentation.
     
    Walsh said their plan is to raise the cost by $250 in Fiscal Year 2025 and another $250 the year after. The expectation is to generate $2.6 million in FY 2025, which begins Oct. 1 and runs through Sept. 30 of next year.
     
    They expect 69% of the costs to be covered by insurance and 25% by Medicaid. But not everyone thinks this is a good way to bring in revenue for the city.
     
    "We need to keep it at a thousand dollars… we call it a charity fund, but it really is an equity fund," District 3 Councilwoman Phyllis Viagran said.
     
    Uninsured residents have the chance to waive their bill through a charity fund created by council members three years ago, but Viagran wants to do more.
     
    She said the constituents in her district are already running low on hospital beds.
     
    "So if there are no more beds… they’re transferred a second time.”
     
    That can be costly. And if the cost of transport goes up, Viagran said, that just adds to the burden.
     
    The Center for Health Equity in South Texas will try to advance community members' health and create better outcomes.
     
    “That’s why I'm supportive of the center of health equity taking a look at that [rate increase]."
     
    Viagran said she is hopeful to look at different ways to find the $2.6 million.


  • 12 Aug 2024 6:42 AM | Matt Zavadsky (Administrator)

    The Urgent Care/ED hybrid model could be an effective Transport to Alternate Destination (TAD) option from communities in which this option is available.  It will be interesting to evaluate which level of service is provided most often.
    ---------------------------- 

    Hospitals, private equity partner to offer urgent care-ER combo
    Phil Galewitz, KFF Health News
    August 09, 2024
     
    https://www.modernhealthcare.com/providers/hospital-private-equity-urgent-care-emergency-room-combination-uf-health-jacksonville
     
    Facing an ultracompetitive market in one of the nation’s fastest-growing cities, UF Health is trying a new way to attract patients: a combination emergency room and urgent care center.
     
    In the past year and a half, UF Health and a private equity-backed company, Intuitive Health, have opened three centers that offer both types of care 24/7 so patients don’t have to decide which facility they need.
     
    Instead, doctors there decide whether it’s urgent or emergency care —the health system bills accordingly — and inform the patient of their decision at the time of the service.
     
    “Most of the time you do not realize where you should go — to an urgent care or an ER — and that triage decision you make can have dramatic economic repercussions,” said Steven Wylie, associate vice president for planning and business development at UF Health Jacksonville. About 70% of patients at its facilities are billed at urgent care rates, Wylie said.
     
    Emergency care is almost always more expensive than urgent care. For patients who might otherwise show up at the ER with an urgent care-level problem — a small cut that requires stitches or an infection treatable with antibiotics — the savings could be hundreds or thousands of dollars.
     
    While no research has been conducted on this new hybrid model, consumer advocates worry hospitals are more likely to route patients to costlier ER-level care whenever possible.
     
    “It’s good to have a place like this that can treat you no matter what,” said Penny Wilding, 91, who said she has no regular physician and was being evaluated for a likely urinary tract infection.
     
    UF Health is one of about a dozen health systems in 10 states partnering with Intuitive Health to set up and run hybrid ER-urgent care facilities. More are in the works; VHC Health, a large hospital in Arlington, Virginia, plans to start building one this year.
     
    Intuitive Health was established in 2008 by three emergency physicians. For several years the company ran independent combination ER-urgent care centers in Texas.
     
    Then Altamont Capital Partners, a multibillion-dollar private equity firm based in Palo Alto, California, bought a majority stake in Intuitive in 2014.
     
    Soon after, the company began partnering with hospitals to open facilities in states including Arizona, Indiana, Kentucky, and Delaware. Under their agreements, the hospitals handle medical staff and billing while Intuitive manages administrative functions — including initial efforts to collect payment, including checking insurance and taking copays — and nonclinical staff, said Thom Herrmann, CEO of Intuitive Health.
     
    Herrmann said hospitals have become more interested in the concept as Medicare and other insurers pay for value instead of just a fee for each service. That means hospitals have an incentive to find ways to treat patients for less.
     
    And Intuitive has a strong incentive to partner with hospitals, said Christine Monahan, an assistant research professor at the Center on Health Insurance Reforms at Georgetown University: Facilities licensed as freestanding emergency rooms — as Intuitive’s are — must be affiliated with hospitals to be covered by Medicare.
     
    At the combo facilities, emergency room specialists make medical decisions that determine whether patients are billed for higher-priced ER care or lower-priced urgent care after patients undergo a medical screening. The health system compares the care needed against criteria for urgent- or emergency-level care and bills.
     
    Inside its combo facilities, UF posts a sign listing some of the urgent care services it offers, including treatment for ear infections, sprains, and minor wounds. When its doctors determine ER-level care is necessary, UF requires patients to sign a form acknowledging they will be billed for an ER visit.
     
    Patients who opt out of ER care at that time are charged a triage fee. UF would not disclose the amount of the fee, saying it varies.
     
    UF officials say patients pay only for the level of care they need. Its centers accept most insurance plans, including Medicare, which covers people older than 65 and those with disabilities, and Medicaid, the program for low-income people.
     
    But there are important caveats, said Fisher, the patient advocate.
     
    Patients who pay cash for urgent care at UF’s hybrid centers are charged an “all-inclusive” $250 fee, whether they need an X-ray or a rapid strep test, to name two such services, or both.
     
    But if they use insurance, patients may have higher cost sharing if their health plan is charged more than it would pay for stand-alone urgent care, she said.
     
    Also, federal surprise billing protections that shield patients in an ER don’t extend to urgent care centers, Fisher said.
     
    Herrmann said Intuitive’s facilities charge commercial insurers for urgent care the same as if they provided only urgent care. But Medicare may pay more.
     
    While urgent care has long been intended for minor injuries and illnesses and ERs are supposed to be for life- or health-threatening conditions, the two models have melded in recent years. Urgent care clinics have increased the scope of injuries and conditions they can treat, while hospitals have taken to advertising ER wait times on highway billboards to attract patients.
     
    Intuitive is credited with pioneering hybrid ER-urgent care, though its facilities are not the only ones with both “emergency” and “urgent care” on their signs. Such branding can sometimes confuse patients.
     
    While Intuitive’s hybrid facilities offer some price transparency, providers have the upper hand on cost, said Vivian Ho, a health economist at Rice University in Texas. “Patients are at the mercy of what the hospital tells them,” she said.
     
    But Daniel Marthey, an assistant professor of health policy and management at Texas A&M University, said the facilities can help patients find a lower-cost option for care by avoiding steep ER bills when they need only urgent-level care. “This is a potentially good thing for patients,” he said.
     
    Marthey said hospitals may be investing in hybrid facilities to make up for lost revenue after federal surprise medical billing protections took effect in 2022 and restricted what hospitals could charge patients treated by out-of-network providers, particularly in emergencies.
     
    “Basically, they are just competing for market share,” Marthey said.
     
    UF Health has placed its new facilities in suburban areas near freestanding ERs owned by competitors HCA Healthcare and Ascension rather than near its downtown hospital in Jacksonville. It is also building a fourth facility, near The Villages, a large retirement community more than 100 miles south.
    “This has been more of an offensive move to expand our market reach and go into suburban markets,” Wylie said.
     
    Though the three centers are not state-approved to care for trauma patients, doctors there said they can handle almost any emergency, including heart attacks and strokes. Patients needing hospitalization are taken by ambulance to the UF hospital about 20 minutes away. If they need to follow up with a specialist, they’re referred to a UF physician.
     
    “If you fall and sprain your leg and need an X-ray and crutches, you can come here and get charged urgent care,” said Justin Nippert, medical director of two of UF’s combo centers. “But if you break your ankle and need it put back in place it can get treated here, too. It’s a one-stop shop.”

  • 12 Aug 2024 6:40 AM | Matt Zavadsky (Administrator)

    This report on the in-home ‘emergency care’ model cites the average ED cost of $2,700 identified by UnitedHealth Group. This may be a good reference point for EMS agencies who are evaluating the economic savings to payers and patients for avoided ED visits. The report also highlights the ongoing challenges with payment models catching up to clinically innovation and patient centric care delivery.

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    In-home emergency care cuts costs, but needs more payer buy-in
    Diane Eastabrook
    June 27, 2024
     
    https://www.modernhealthcare.com/providers/emergency-room-care-at-home-growth-challenges
     
    At-home emergency care is gaining momentum — and could cost millions less — but reimbursement challenges create an access barrier for some patients.
     
    Deploying healthcare in patients' homes gained traction during the COVID-19 pandemic as a way to ease overcrowding at hospitals and prevent the virus from spreading. Emergency department care at home lets patients bypass the waiting room through referrals from hospitals or primary care providers if they determine patients do not have life-threatening illnesses or injuries. While many private insurers reimburse for such care, traditional fee-for-service Medicare and Medicaid do not pay for it as a stand-alone service.
     
    Emergency department-at-home programs deploy paramedics or nurses to check vital signs, draw blood and take x-rays with portable imaging devices. Physicians supervise the visits via telehealth, then refer patients to primary care providers for further treatment or to hospital emergency departments if more complex care is needed.
     
    Healthcare technology company Medically Home and primary care provider Atrius Health, a division of UnitedHealth Group's Optum Health, offer emergency department-care-at-home through a partnership in the Boston area. A study they published last week in the New England Journal of Medicine found more than 83% of 3,668 patients who received emergency care at home over two years did not require a trip to the hospital, saving Atrius approximately $4.5 million.
     
    Medically Home launched its service in 2020 and has served approximately 7,000 patients through contracts with three provider groups, including Atrius. The primary care provider has value-based care contracts with most of its patients and takes on the full risk for their care.
     
    Hospital emergency departments are the default care option for many Americans and are expected to account for about 150 million visits this year, according to the Emergency Department Benchmarking Alliance, a nonprofit that represents more than 2,000 emergency departments. They are also the most expensive places to get healthcare. The average emergency department visit costs about $2,700 versus $185 at an urgent care facility, according to UnitedHealth Group’s website.
     
    Companies including Medically Home and Denver-based DispatchHealth see emergency department-at-home as a huge opportunity to save millions of dollars in unnecessary hospital visits.
     
    “Health systems sometimes get overrun and they want to make sure that patients get the right type of care," said Dr. Phil Mitchell, DispatchHealth's chief medical officer. “In some circumstances, they are actually actively looking to decant what comes into their emergency department.”
     
    DispatchHealth launched its emergency department-at-home program in 2015 and has partnerships with 150 health plans, value-based care providers and health systems. The company has provided care to 1.2 million patients in 50 locations across 23 states, according to Mitchell. It wants to bring the service to another seven locations by the end of this year.
     
    Falls Church, Virginia-based Inova Health Systems contracted with DispatchHealth two years ago to treat some patients in their homes. The service helps the hospital free up beds for sicker patients and helps emergency medical assistance teams turnaround ambulances more quickly, said Toni Arabell, Inova Health System’s chief clinical officer of enterprise operations.
     
    New providers are also jumping into at-home emergency care, including Minnesota-based Lifespark, which operates senior living facilities and provides primary care and home health services to about 20,000 older adults in the Minneapolis area. On Tuesday, the company launched an urgent response service that will provide in-home emergency department care to patients enrolled in certain Medicare Advantage plans who live in its communities or receive primary care services from Lifespark.
     
    CEO Joel Theisen said urgent response aims to close care gaps for about 3,000 chronically ill older adults who frequently use hospital emergency departments and can cost Lifespark thousands of dollars per visit.
     
    “The igniter for setting off the bomb of costs is the acute hospital event,” Theisen said. “If you can keep them out of the emergency room, everyone wins big.”
     
    Still, a large cohort of patients covered by traditional fee-for-service Medicare and Medicaid don’t have access to home-based emergency department care because those government programs don't fully cover for the service.
     
    A spokesperson for DispatchHealth said the company is reimbursed for urgent medical services by Medicare and Medicaid, but the programs may not fully cover the cost of care. The company is optimistic traditional Medicare and Medicaid will eventually pay for the entire service, the spokesperson said.
     
    Medically Home plans to continue expanding the emergency department-care-at-home program despite reimbursement gaps, according to Dr. Greg Snyder, the company’s vice president of clinical strategy and quality improvement. But he said getting buy-in from all payers would be helpful.
     
    “We need to be delivering the service innovations that are going to support the home-based care ecosystem and [emergency department]-at-home is one of those things,” Snyder said.

  • 9 Aug 2024 7:09 AM | Matt Zavadsky (Administrator)

    Insider analysis: ‘What truly matters in EMS systems’

    A coalition of EMS organizations advocates for new performance indicators that prioritize effectiveness, safety, satisfaction, equity and efficiency over traditional response times

    August 08, 2024

    The Overrun Podcast & Blog

    What happened: On July 31st, a significant shift in evaluating EMS performance metrics was heralded by the publication of a joint statement from 16 prominent EMS organizations. This initiative involves key players like the American Ambulance Association, the American College of Emergency Physicians and the International Association of EMS Chiefs.

    This diverse coalition seeks to redefine the key performance indicators (KPIs) for EMS systems, emphasizing metrics that are effective, safe, satisfying, equitable and efficient.

    16 EMS groups publish joint statement on EMS performance metrics

    Highlights

    Watch as Ed Bauter, MBA, MHL, NRP, FP-C, CCP-C; and Daniel Schwester, MICP, highlight the significance of this development, including:

    • A move away from response times. Historically, response times have dominated as the primary measure of EMS system quality. However, growing evidence suggests that response times alone do not correlate with improved patient outcomes. The joint statement challenges the long-held belief that faster response times equate to better patient care.
    • Reduced red lights and sirens. The statement draws attention to the inherent risks associated with the use of red lights and sirens, which have been shown to increase the likelihood of collisions by up to 60%. These incidents not only endanger patients and providers but also civilians. The focus now is on using lights and sirens only when they provide a direct, demonstrable benefit to patient outcomes.
    • A nuanced approach to performance metrics. This shift represents a fundamental change in EMS practice, advocating for performance indicators that reflect the quality of care provided, rather than the speed of response. The coalition’s unified stance marks a critical step towards a more comprehensive and patient-centered approach to EMS evaluation.

    As EMS systems nationwide begin to adopt these new metrics, the focus will likely shift towards improving the overall quality and safety of patient care.

    This evolution in performance measurement promises to enhance the effectiveness and reliability of EMS services, ultimately benefiting patients, providers, and communities alike.


  • 31 Jul 2024 11:03 AM | Matt Zavadsky (Administrator)

    EMS is the subject of many current legislative proposals, all of these very favorable for EMS agencies, and the communities they serve. 

    If you would like to support any of these initiatives with a letter to your members of congress, visit: https://naemt.org/advocacy/online-legislative-service#/ 

    Current EMS Economic Legislation

    Treatment In Place (EMS ROCS Act): S.3236 and H.R.6257

    Improving Access to Emergency Medical Services Act: H.R. 8977

    Community Paramedicine Act of 2024: H.R. 8042

    SIREN Reauthorization: S.265 and H.R. 4646

    Medicare Extenders: S.1673 and H.R. 1666

    EMS Counts: S.1115 and H.R. 2574

    VA Emergency Transportation Access Act: S.2757

    ------------------- 

    Medicare patients could get emergency treatment at home under new bill

    The proposal could give 67.2 million Medicare enrollees more flexible treatment choices

    By Jessica Hall

    July 31, 2024

    https://www.marketwatch.com/story/medicare-patients-could-get-emergency-treatment-at-home-under-new-bill-aa394ca3

    A new proposal in Congress would allow older Medicare recipients to receive emergency medical services at home rather than having to be transported to a hospital for care, which could help them avert potential health and financial consequences resulting from a hospital visit.

    The proposal, called the Improving Access to Emergency Medical Services for Seniors Act, would allow people to receive care at home for minor but urgent medical incidents instead of being sent to a hospital, where they risk long waits, hospital-acquired infections and higher costs.

    Under the proposal, a pilot project would be created to demonstrate the financial and medical impact to Medicare of reimbursing paramedics and emergency medical technicians for treating patients in place.

    The bill was introduced by a bipartisan group of representatives, including New York Democrat Pat Ryan, Ohio Republican Mike Carey, Texas Democrat Lloyd Doggett, West Virginia Republican Carol Miller and Michigan Democrat Debbie Dingell.

    "Not every patient is best served by an emergency room visit," Carey said in a joint statement from the lawmakers. "In fact, for many seniors, a trip to the hospital can mean long wait times, increased costs and potentially life-threatening complications."

    The proposal would end a requirement that Medicare patients be transported to emergency healthcare facilities in order for providers to receive reimbursement, thus allowing emergency responders to receive compensation for in-home care they provide. Patients would still be taken to a hospital's emergency department if needed, but under the proposal, they could, when possible, be treated at home.

    People 60 and older account for nearly 20% of all emergency-room visits, according to the Centers for Disease Control and Prevention.

    Patients who received care through treatment-in-place programs had experiences similar to or better than those treated in a hospital, according to a study published in JAMA in 2021. They faced similar mortality risk, a 26% lower hospital readmission risk and a lower risk for admission into a long-term care facility compared with their counterparts treated in hospitals, the study found.

    Medicare is federal health insurance that covers people age 65 and older, as well as some people under 65 who have certain disabilities or medical conditions. As of March 2024, more than 67.2 million people were covered by Medicare or Medicare Advantage programs, according to the Centers for Medicare and Medicaid.

    "Treating patients immediately at home and preventing an emergency room trip is sometimes both the best way to help the patient and the taxpayer," Doggett said in the statement.

    In rural areas, some older people live hours from an emergency room and would benefit from being treated at home by emergency personnel, Miller said.

    "Allowing EMTs to be reimbursed for this care and preventing unnecessary hospital visits would be an immense cost-saver for Medicare, free up emergency room space for those who really need critical care, and improve quality of life for our seniors," Dingell said in the statement.

    The bill has received support from the National Rural Health Association, International Association of Fire Chiefs, International Association of Firefighters, American Ambulance Association, Congressional Fire Service Institute, National Association of Towns and Townships and the National Association of Emergency Medical Technicians.

  • 30 Jul 2024 4:29 PM | Matt Zavadsky (Administrator)

    COMMUNITY RELEASE: Top EMS Groups Publish Joint Statement on EMS Performance Metrics – Beyond Response Times

    Sixteen national and international EMS, patient safety and public policy associations have partnered on the release of a Joint Statement on EMS Performance Metrics – Beyond Response Times.

    The joint statement encourages EMS systems and community leaders to implement an approach to EMS system performance that prioritizes patient-centered care and uses a broad, balanced set of clinical, safety, experiential, equity, operational, and financial measures to evaluate the effectiveness of EMS systems.

    The endorsing associations include:

    • Academy of International Mobile Healthcare Integration

    • American Ambulance Association
    • American College of Emergency Physicians
    • American College of Surgeons – Committee on Trauma
    • American Paramedic Association
    • Center for Patient Safety
    • International Academies of Emergency Dispatch
    • International Association of EMS Chiefs
    • International City/County Management Association
    • National Association of EMS Physicians
    • National Association of Emergency Medical Technicians
    • National Association of State EMS Officials
    • National EMS Management Association
    • National EMS Quality Alliance
    • National Volunteer Fire Council
    • Paramedic Chiefs of Canada

    These associations recommend that local communities and governments modernize the assessment of the performance of their EMS systems/agencies by evaluating a broad array of domains with key performance indicators (KPIs) that can be measured and trended over time, and whenever possible, benchmarked with comparable EMS systems, or other national data, and published to local community stakeholders on a regular basis.

    “Historically, response time performance has been the primary measure used to assess the quality of an EMS system. However, response times have not generally been associated with improved patient outcomes in the growing body of EMS evidence and research, and the reliance on response time performance prevents communities from evaluating other EMS system quality measures that have greater significance for patient care and outcomes”, states Dr. Doug Kupas, the primary author of the Joint Statement.

    Matt Zavadsky, one of the contributing authors of the statement adds “This Joint Statement is the second major collaboration for most of these national and international associations, representing a significant coalescence of these associations, including public policy makers, to help assure that evidence-based clinical, operational, experiential and financial measures are used to more appropriately evaluate system performance.” 

    The prior Joint Position Statement from these groups encouraged EMS agencies to reduce lights and siren responses to improve community and patient safety.

    The Joint Statement includes the domains that should be used when evaluating an EMS system/agency including:

    • EffectiveIs the health care provided clinically appropriate and high quality?

    • Safe: Are services being provided in a way that is clinically and operationally safe for patients, responders, and the community?
    • Satisfying: How do patients and EMS clinicians feel about the service being provided?
    • Equitable:  Is the system providing care that is equitable based on patient demographics and service area geography?
    • Efficient:  Is this service being provided in a way that maximizes the use of economic and operational resources?

    The participating associations emphasize that it is essential for government and community leaders and decision-makers to consider all elements of the EMS system from the moment a 9-1-1 call is made to the conclusion of care by the EMS system/agency. 

    By considering these additional performance measures, local communities can gain a more comprehensive understanding of the effectiveness of their EMS system/agency, identify areas for improvement in patient care, system efficiency, and overall emergency response capabilities.

    The Joint Statement on EMS Performance Metrics – Beyond Response Times can be found here: https://doi.org/10.1080/10903127.2024.2375739

    A PDF of the document can be downloaded here:


    A resource guide for effective evaluation of EMS systems can be downloaded at the link below:

    References-Resources on Response Times^LJ All ALS^LJ and EMS Performance Measures Updated 11-8-24.pdf


     


  • 30 Jul 2024 9:13 AM | Matt Zavadsky (Administrator)

    Interesting insight from a former elected official in Manitoba, Canada

    Although the context is Canadian, the issue is very similar in many U.S. communities.

    Thankfully, elected and appointed officials, and brave EMS agency leaders, are appropriately driving EMS delivery changes, using evidence-based research to 'right-size' response plans for low-acuity calls, deploying ALS, BLS, CIT and community paramedic units to low-acuity calls, and preserving valuable medical first response resources for high-acuity calls by assuring they are NOT on low-acuity calls.

    -------------- 

    Firefighters need to focus on core jobs

    By: Rochelle Squires

    Jul. 30, 2024

    https://www.winnipegfreepress.com/opinion/analysis/2024/07/30/firefighters-need-to-focus-on-core-jobs

    It takes an average of six minutes for a house to become engulfed in flames. Not every house, of course. Depending on the building materials and contents inside, it may burn slower or faster, with newer builds typically experiencing structural failure quicker than a house made of traditional lumber. In those instances, especially, if firefighters aren’t on the scene immediately, it takes almost no time for it to collapse and burn to the ground.

    Thankfully, there’s a fire department nearby. Not just in my south St. Vital neighbourhood where I am three minutes away from a station, but in every community throughout the city.

    I’ve had to call 911 exactly two times in my life, both for a loved one’s emergent medical crisis that was thankfully rectified, one with a hospital visit and one without. Of course, as anyone who has ever called 911 knows, it’s not usually the paramedics in an ambulance that arrive first, but a fire engine and four firefighters with at least one dually trained as a paramedic.

    Yet having a fire hall close by does not always guarantee a fast response for a fire or medical emergency.

    Consider this: the Winnipeg Fire Paramedic Services is one of the busiest departments in North America on a per capita basis, surpassing cities like Detroit, Chicago and Los Angeles, yet resources have not kept pace.

    In the Canadian context, the WFPS nearly quadruples fire calls in places like Toronto and Calgary. Further, Winnipeg’s firefighters battle more fires of significance than any other jurisdiction, meaning Winnipeg has a greater frequency of big fires that take more than an hour to fight and require multiple apparatus on scene.

    This alone should be a substantial part of any firefighter’s job. Yet ask anyone working in the department today and they’ll undoubtedly tell you that a significant part of the job nowadays is also doing things they weren’t trained to do and don’t always have the capacity for, causing incredible strain on the service and its members.

    Put bluntly, today’s firefighters spend countless hours attending non-emergent calls where there is no fire or safety hazard present.

    Almost a daily occurrence now, firefighters provide well-being checks for people who are not experiencing medical emergencies and respond to mental health crises. It’s also not uncommon for them to get sent to scenes because someone is acting aggressively or belligerent, are expected to intervene in incidents of vandalism and other criminal activity, and even get involved in domestic violence situations.

    Undoubtedly, in most of the above-mentioned cases, intervention is necessary. But surely there’s got to be a better response to non-emergent situations than sending fire apparatus and a team of firefighters. Not only is it creating workload issues, fatigue and burnout, it’s putting us in danger.

    That’s because non-emergent calls routinely tie up emergency resources to the point of creating vulnerabilities or gaps in service. It is a growing concern that in any given week, there are moments when resources are unavailable, and if a catastrophe or a major blaze erupts, there’ll be a delay in the arrival of life-saving resources.

    In other words, if my house caught on fire and there was six minutes on the clock before it became fully engulfed, even though I’m only three minutes from a fire hall, resources may not arrive in time.

    So what needs to be done?

    The province has stepped up in a few ways, including a $20 million boost to ambulance funding by my former government, and the current government deserves kudos for providing new funding for 40 more firefighters.

    Yet additional cash isn’t the sole answer when the system needs a reboot.

    For starters, empowering dispatch resources to find alternate responses for non-emergent situations is worth looking at. Yes, it’s complex. People calling 911 deserve to be treated first with an assumption there is an emergency. But when it is clear that there is no emergency, what then? Alternatives to sending a battalion of fire resources should be considered, including an expansion of the community paramedic program where personnel are trained to handle some of the aforementioned calls.

    Firefighters also spend countless hours sitting with stable patients waiting to go to hospital. Expanding transportation options would also go a long way in ensuring life-saving resources are available when most needed, and firefighters should have the ability to disengage and be made available for prioritized emergencies.

    As stated before, it’s a complex problem needing a comprehensive solution. But nothing is more complex than waiting on help in a time of emergency.

    Rochelle Squires is a recovering politician after 7 1/2 years in the Manitoba legislature. She is a political and social commentator whose column appears Tuesdays. rochelle@rochellesquires.ca



  • 24 Jul 2024 6:16 AM | Matt Zavadsky (Administrator)

    For a list of the 15 recommendations voted on by the Advisory Committee on Ground Ambulance and Patient Billing (GAPB), and the voting history, click on the file links below:

    04_GAPB_ PPT_Mtg3_D1_ Recommendations_V4_11.08.2023_508.pdf   

    Ground Ambulance and Patient Billing -Third Meeting Voting Summary_V03_508.pdf

    --------------------------- 

    Plan to end exorbitant ‘surprise’ ambulance bills heads to Congress

    Committee to recommend patients should pay no more than $100 or 10% of a bill, depending on which is less

    By Jessica Glenza

    July 21, 2024

    https://www.theguardian.com/us-news/article/2024/jul/21/ambulance-surprise-bills-congress

    A committee chartered to find ways to stop ambulances from sending patients exorbitant bills is set to tell Congress that patients should pay no more than $100 or 10% of a bill, depending on which is less.

    The recommendation, which still relies on the convoluted private insurance industry, comes as nearly half of all ambulance rides in the US result in a “surprise bill” of often hundreds of dollars.

    “America has decided to use an insurance system to spread the risk among many,” said Patricia Kelmar, senior director of healthcare campaigns at US Pirg, a consumer advocacy group.

    “But when it comes to ambulances, without a surprise billing protection, that risk isn’t spread – the person who needs the ambulance is paying a lot more than anyone else who has that insurance.”

    Kelmar was the lone consumer spokesperson on the committee formally known as the Advisory Committee on Ground Ambulance and Patient Billing. Other committee members included emergency service providers, ambulance companies, insurance industry insiders and representatives of federal agencies.

    The committee was chartered when the former president Donald Trump signed the No Surprises Act in 2020 – a bipartisan bill to stop patients from receiving “surprise bills”. Although the legislation stops an estimated 10m surprise bills a year from reaching patients, ground ambulances are conspicuously excluded.

    Surprise bills are in effect a dispute between insurance companies and healthcare providers. When a person takes an ambulance that is not directly contracted with an insurance company, they can bill insurance any amount they please. The remainder of the bill is then the patient’s responsibility. Hence, surprise bills are often called “balance bills”. And they can cost thousands.

    For instance, Theo is a Washington state infant who arrived earlier than expected and needed to be transferred between hospitals for specialized care. The hospital ordered the ambulance, and the family was grateful for the good care.

    Then the family received a $7,000 bill.

    Insurance paid only a small portion – $1,000. The family tried to negotiate with both the ambulance and insurance companies, but were rebuffed. Now, they are now on a 30-month payment plan. Theo will be nearly three years old by the time the balance is satisfied.

    “The hospital arranged the transportation, we didn’t have a say,” the parents said, in a presentation by Pirg. “We are grateful for the care, but surprised that even though we have good insurance we owe so much because the ambulance was out-of-network.”

    Part of the reason Congress has found it difficult to regulate ground ambulances is because there are so many parties to please. Ambulances were once considered a public good and were funded by the federal government. But in 1981, the Reagan administration transformed funding for emergency medical transportation into limited block grants which states could then spend as they wish.

    With federal funding diminished and states facing varying political and budget pressures, localities closed some public facilities, contracted with private companies and both began to seek payment from health insurance companies.

    Now, a hodge-podge of private and public entities provide emergency medical transport, and stick patients with surprise bills as much as half of the time, according to Pirg. Privately insured Americans paid an average of $129m in surprise ambulance bills between 2013 and 2017, according to an article examining the problem in the journal Health Affairs.

    Private equity has also prospered. Two of the three largest ground and air ambulance companies are now owned by private equity, which in some places has resulted in aggressive billing and collections.

    “There was no discussion of whether or not we were going to ban balance billing,” said Dr Ritu Sahni, an emergency medicine doctor and a committee member at a panel discussion on their findings. “Balance billing created a barrier to good healthcare. But it was the ‘yes and’ component – how do we ensure the safety and survival of our community by making sure the future of the EMS service was secure?”

    The committee coalesced around a set of recommendations to Congress that continue to rely on private insurance. They said patients with private insurance should be covered when they call 911 or are transferred between hospitals, like Theo’s family. A patient should pay no more than the lesser of 10% of a bill or $100. And, insurance should pay ambulances in a timely manner.

    Although the committee published its top-line findings, the full report will not be available until it is sent to Congress, which is expected in the coming weeks. Whether Congress will act on the recommendations is unclear. Eighteen states offer some kind of consumer protection from surprise ambulance bills.

    “In many ways we’re locked into the system we have and we’re trying to solve for the system we have,” said Kelmar. “But it’s a really important public policy question to know: should we keep this system? Is this the way we want to pay for emergency transportation service? Do we want private equity running ambulance services in communities?”


  • 15 Jul 2024 6:20 AM | Matt Zavadsky (Administrator)

    EMS agency and community leaders should monitor developments like this to assure logical public policy that modernizes EMS reimbursement to include reasonable reimbursement rates and coverage for valuable Treatment in Place (TIP) and Transport to Alternate Destinations (TAD) remain in place.

    It's also a good reminder that during legislative processes, all stakeholders should be engaged in the process.

    --------------------- 

    Health insurance advocacy group seeks to block ambulance reimbursement bill
    By Anthony Warren
    Jul. 12, 2024
     
    https://www.wlbt.com/2024/07/12/health-insurance-advocacy-group-seeks-block-ambulance-reimbursement-bill/
     
    JACKSON, Miss. (WLBT) - An advocacy group for health insurance providers in the state wants to block a new law that would increase how much its members would have to pay ambulance companies for certain services.
     
    The Mississippi Association of Health Plans (MAHP) recently filed for an injunction to block the State Insurance Commissioner from implementing H.B. 1489.
     
    The petition was filed on June 28 in U.S. District Court for the Southern District of Mississippi, just days before the new law was set to take effect.
     
    The bill, which was signed by Gov. Tate Reeves on May 2 after passing both the House and Senate on unanimous votes, requires insurance providers to compensate ambulance companies for certain services they previously were not paid for.
     
    That compensation would be what is charged under the ambulance’s contract with a city or county, or 350 percent of the reimbursement rate of Medicare, whichever is larger.
     
    Among concerns, MAHP argues the law is too vague to understand, and that provisions of the measure could drive up healthcare costs for customers. Additionally, the group is concerned about what impact the new law has on health insurance policies already in place.
     
    “The vague language will create uncertainty for MAHP’s member plans, leaving plans without direction as to what claims may require coverage and what claims may not,” the suit states. “Furthermore, the significant lack of clarity will leave the interpretation and enforcement of these provisions to the sole discretion of the Commissioner [of Insurance]... or to courts deciding whether a denied claim is required to be covered as a matter of law.”
     
    H.B. 1489, the “Mississippi Triage, Treat and Transport to Alternate Destination Act,” was passed during the 2024 legislative session and signed into law by Gov. Tate Reeves. The measure took effect on July 1.
     
    The bill, in part, increases how much insurance companies must pay ambulance firms for services provided.
     
    H.B. 1489
     
    The measure also mandates insurance providers reimburse EMTs for services that they were previously not reimbursable, such as instances where individuals are treated in place or are transported to “alternative destinations” other than emergency rooms.
     
     
    1489 defines those destinations as federally qualified health centers, urgent care centers, physician’s offices or medical clinics, and behavioral health facilities.
     
    Currently, EMTs can transport individuals to those locations but are not reimbursed by insurance companies for doing so.
     
    Rep. Stacey Hobgood-Wilkes rejects the lawsuit, saying ambulances shouldn’t have to provide services for free. “If you provide a service, you should be compensated for it,” she said. “Without adequate reimbursement for these services, the citizens of Mississippi will not receive the reliable, high-quality care they deserve and pay for.”
     
    Figures provided by the Ambulance Alliance show EMS providers in the state charge between $988 and $1,224.82 for a basic life support emergency response in urban areas. Medicare reimburses those companies just $398.56.
     
    MAHP takes issue with the bill’s use of the phrase, “including but not limited to” endlessly expands the list of destinations insurance companies now must pay for.
     
    “As written, it is substantially unclear what constitutes an ‘alternative destination’ and if an ‘alternative destination’ includes medical providers who do not provide any degree of emergency medical services, such as a dermatologist, pharmacist, chiropractor, and the like,” the suit states.
     
    MAHP members include Amerigroup, CareSource, Cigna Healthcare, CVS Health, Magnolia Health, Molina Healthcare, TrueCare, United Healthcare, and others. A list of members can be found here.
     
    The group also takes umbrage with the bill’s requirement that insurance providers reimburse ambulances for “encounters” between EMTs and those seeking medical help.
     
    Under the act, third-party payers would be required to pay for treatment in place when a patient is not transported to an emergency room. Before the passage of the bill, EMTs were only reimbursed if a patient was taken to the hospital.
     
    That amount of the reimbursements would be the local fees set by a city or county contract or 325 percent of Medicare, whichever is greater. In the absence of a local rate, the ambulance provider would be paid their billed charges or 325 percent of Medicare, whichever is greater, the bill states.
     
    However, MAHP says the law does not say what level of service would have to be provided, only that the service must be initiated by a 911 call.
     
    The group also is unsure whether companies are required to pay the reimbursements under current insurance plans, or if they would only be required to do so under plans issued after the law took effect.
     
    “These unintelligible provisions create no standard at all and/or cause House Bill 1489, Section 1 to be substantially incomprehensible,” the suit states. “Section 1 does not give a person of ordinary intelligence a reasonable opportunity to know what is prohibited, and increases the risk of arbitrary application and enforcement.”
     
    MAHP is asking the court for a summary judgment ruling that Section 1 of H.B. 1489 violates the due process clause of the Fourteenth Amendment to the Constitution; it also is asking the court to void Section 2 of the bill, saying it violates the Constitution’s Contract Clause.
     
    The group is also asking the court to prevent the state to implement or take any action to enforce provisions of the bill being challenged.

  • 12 Jul 2024 10:02 AM | Matt Zavadsky (Administrator)

    Special thanks to Rep. Carey for introducing H.R. 8977 the 'Improving Access to Emergency Medical Services Act of 2024' yesterday. 

    This marks the 3rd active bill in Congress to change the economic model for EMS from a transport-based reimbursement model to a 'response-based' model; in essence, reimbursing for the CARE we provide vs. the transport we supply.

    The 2 other bills are S. 3236 & H.R. 6257, the Emergency Medical Services Reimbursement for On-scene Care and Support Act (EMS ROCS).

    Congress has been very engaged with the EMS economic model for the past year. In March, 2024, the House Ways and Means Committee recently held a field hearing on access to emergency care with Dr. Ed Racht and Matt Zavadsky as invited experts to provide testimony and participate in a 3-hour Q & A session with the committee members. 

    You can watch the EMS-related testimony and the Q & A with the Committee members here.

    Carey Leads Effort to Expand Emergency Medical Treatment Options for Seniors
     July 11, 2024

     
    WASHINGTON, D.C. - Today, Representatives Mike Carey (OH-15), Lloyd Doggett (TX-35), Carol Miller (WV-01), Pat Ryan (NY-18) and Debbie Dingell (MI-12) introduced the bipartisan Improving Access to Emergency Medical Services for Seniors Act. The bill would allow seniors on Medicare to receive at-home emergency medical services to treat minor medical incidents.
     
    “Not every patient is best served by an emergency room visit,” said Congressman Carey. “In fact, for many seniors, a trip to the hospital can mean long wait times, increased costs and potentially life-threatening complications. We’re proud to lead this bill to give our seniors access to the highest caliber of care.” 
    Treatment-in-place options for emergency medical reduces costs, increases convenience and protects seniors from potentially life-threatening infections.
     
    Adults aged 65 and older account for nearly 20 percent of all ER visits. This population contributes to the backlog in waiting rooms, even when they might not have an issue requiring inpatient treatment. In a 2021 study, patients who received at-home care had a lower risk for readmission by 26 percent and a lower risk for long-term care admission as compared to patients who received in-hospital treatment.
     
    “Treating patients immediately at home and preventing an emergency room trip is sometimes both the best way to help the patient and the taxpayer. Our legislation to establish a Medicare pilot program is designed to show the effectiveness of fair pay to first responders for such services. Thereby we hope to encourage a permanent payment system for treatment in place,” said Rep. Doggett.
     
    Emergency Medical Services (EMS) providers are at the frontline of delivering care and transportation in rural America. In West Virginia, many patients live hours from a hospital and must consistently rely on EMS for treatment. Our EMS personnel are equipped to provide care to patients that may not be in a dire medical situation, rather than spend precious time and resources on transporting non-emergency patients to a hospital emergency department. This commonsense legislation builds upon the Treatment-in-Place Model to provide timely care to our rural patients and empower EMS providers, and I will continue to work to improve access to quality health care for patients in West Virginia and across the U.S.” said Congresswoman Miller.
     
    “Our grandparents, neighbors, and friends are safer and healthier because of the dedicated care paramedics and EMTs provide to our community,” said Congressman Pat Ryan. “They deserve to be compensated – no matter where they administer care. That’s why I’m proud to co-lead the Improving Access to Emergency Medical Services Act to ensure that our highly trained first responders are fully supported in continuing to save lives and serve our seniors. I will keep fighting for the resources that our first responders need and deserve.”
     
    Rep Dingell said, “We should be making it easier for seniors to live and receive the care they need at home and in their communities. The Improving Access to Emergency Ambulance Services Act will allow seniors to receive this care that can easily be provided at home by EMT professionals rather than paying for a hospital visit. Allowing EMTs to be reimbursed for this care and preventing unnecessary hospital visits would be an immense cost-saver for Medicare, free up emergency room space for those who really need critical care, and improve quality of life for our seniors.”
     
    The bill has received support from the National Rural Health Association, International Association of Fire Chiefs, International Association of Firefighters, American Ambulance Association, Congressional Fire Service Institute, National Association of Towns and Townships and the National Association of Emergency Medical Technicians.
      
    Randy Strozyk, President of the American Ambulance Association said, "We greatly appreciate the leadership of Representatives Mike Carey, Lloyd Doggett, Carol Miller, Debbie Dingell and Pat Ryan in laying the foundation for future Medicare reimbursement of vital ambulance services provided at the scene of a patient in need of medical care but doesn't require a transport to a health care facility. The Improving Access to Emergency Ambulance Services Act will establish a pilot project that will demonstrate the financial and medical benefits to the Medicare program of reimbursing for treatment in place of patients by paramedics and emergency medical technicians."
     
    Susan Bailey, MSEM, NRP, President of NAEMT, remarked: "EMS is an integral part of our nation’s healthcare system and has been proven effective in the health continuum. EMS Practitioners are now providing medical care in a variety of settings. Our role has become much broader than ambulance transport. NAEMT has long advocated for providing EMS agencies the flexibility to navigate patients to the right care in the right setting through federal and state reimbursement of Treatment in Place (TIP). We applaud Rep. Mike Carey, Rep. Lloyd Doggett, Rep. Carol Miller, Rep. Pat Ryan and Rep. Debbie Dingell for their leadership and introduction of the Improving Access to Emergency Medical Services Act of 2024.
     
    Reimbursing EMS agencies for TIP will save Medicare billions of dollars on unnecessary emergency department visits, enhance patient experience, shorten task times for EMS agencies struggling with workforce shortages, help decompress overcrowded hospitals and emergency departments, and meet patients’ needs without long waits at the hospital.”
     
    “EMS is a fundamental, core service that fire departments provide in their communities. Fire fighters are among the most skilled and experienced pre-hospital emergency care providers in the nation, and it is long past time that we reimburse them for the full range of care that they give to ill and injured patients. Updating Medicare’s reimbursement policies is a common-sense way to drive EMS innovation and improve the patients’ experiences during medical emergencies. The IAFF applauds Reps. Carey, Doggett, Miller, Ryan, and Dingell for their bipartisan leadership in developing this bill, and we urge Congress to answer our call to bring EMS into the 21st century,” said IAFF General President Edward A. Kelly
     
    “I thank Representatives Carey, Doggett, Miller, Ryan, and Dingell for introducing this legislation to reimburse fire and EMS departments for treating Medicare patients in places like their homes,” said Fire Chief John S. Butler, Fairfax County, VA and International Association of Fire Chiefs President and Board Chair. “This legislation will allow some of our nation’s most vulnerable citizens to receive necessary care without the trauma and expense of being transported to the hospital. It also ensures that fire and EMS departments only must transport patients if it is medically necessary, which frees up vital EMS and hospital resources. This program will be a win-win for both Medicare patients and emergency response agencies.”
     
    Full text of the bill is available here.

     
     


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